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State Medicaid Expansion and Reform Activity - 19 April 2016

A political maneuver to secure funding for "Arkansas Works," Governor Asa Hutchinson's (R) plan to extend and reform the State's Medicaid expansion, is underway after the appropriation bill failed to receive the three-quarters majority vote required for passage. The Joint Budget Committee has approved an amendment that would technically end the program in December 2016; however, according to local media, the bill as amended is expected to pass the Senate and House, and then head to the Governor who has pledged to use a line-item veto to remove the provision, effectively preserving the program's funding. The Governor's veto can be upheld by a simple majority vote. Votes in the Senate and House are expected over the next two days.

Maine: Sixth Medicaid Expansion Veto Expected

The State Legislature approved Medicaid expansion for the sixth time last week, but not by sufficient margins to overturn Governor Paul LePage's (R) anticipated veto. The current proposal would cover individuals up to 100% of FPL through regular MaineCare (Medicaid) and provide subsidies for individuals between 100% and 138% of FPL to purchase qualified health plans on the Marketplace. The non-partisan legislative fiscal office estimated that approximately 80,000 adults would become eligible for coverage. Maine previously covered some childless adults up to 100% of FPL, but dropped this coverage in 2014, the year of Governor LePage's most recent Medicaid expansion veto.

The Ohio Department of Medicaid released a draft 1115 waiver application describing the "Healthy Ohio Program," under which all adult Medicaid beneficiaries eligible for Medicaid through the Ohio Covered Families and Children program (the State's pre-expansion population) or the Medicaid expansion would enroll in a high-deductible Medicaid managed care plan and receive a health savings-like account (the "Buckeye Account"), into which the State would deposit $1,000. Enrollees (with the exception of pregnant women) would also be required to contribute the lesser of 2% of their income or $8.25 each month into their Buckeye Account, and would be disenrolled if they failed to do so after a 60-day grace period. Account funds would be used to pay the plan's copayments and deductible, and could be supplemented with incentive payments for meeting preventive care goals. Enrollees would be subject to an annual and lifetime benefit spending cap, which, if exceeded, triggers a transition to traditional managed care or fee-for-service coverage. Enrollees who become ineligible for the program due to an increase in income could apply their account balance to premiums or cost sharing for Marketplace or employer sponsored coverage.

Rhode Island: 20,000 to Be Enrolled in State's First Medicaid Accountable Care Entity

Rhode Island is launching its first "accountable care entity" for Medicaid enrollees as part of Governor Gina Raimondo's (D) Reinventing Medicaidinitiative. The entity is a partnership between UnitedHealthcare and the newly formed Integra Community Care Network and will provide care to 20,000 individuals currently enrolled in the State's UnitedHealthcare Medicaid plan. As part of the entity's efforts to improve health outcomes and reduce the overall cost of care, the network of providers, which includes the State's largest primary care group, will offer services during evenings, weekends, and holidays as a way to reduce emergency room visits. In addition, community-based health workers and care managers will help coordinate care, and data provided by United to patients' care teams will enable providers to identify high-risk patients and gaps in treatment.

Tennessee: New Committee to Propose Medicaid Reforms

House Speaker Beth Harwell (R) appointed a new legislative task force to consider reforms to the State's Medicaid program after supporters of Insure Tennessee, Governor Bill Haslam's (R) Medicaid expansion plan, launched a media campaign criticizing the Speaker for refusing to bring Medicaid expansion to a floor vote. Harwell said the four-person task force will develop pilot projects based on "conservative ideas," including potentially health savings accounts and support for enrollees transitioning into the workforce, acknowledging that some proposals may require federal approval. The pilots will be phased in and the task force will also identify cost targets for pilot programs that, if surpassed, would halt further implementation of the pilots. State Democrats criticized the announcement as an attempt to deflect attention away from Medicaid expansion. Insure Tennessee was defeated in committee last year. The task force intends to have a report ready in June for proposed meetings with CMS.

Texas requested a 15-month extension to its 1115 waiver to maintain current funding levels for the Uncompensated Care and Delivery System Reform Incentive Payment (DSRIP) programs and to continue operations under the statewide managed care delivery model. If granted, $3.1 billion would be allocated to the Uncompensated Care and DSRIP programs for twelve months beginning October 1, 2016, and a prorated amount would be allocated for the additional three months. Texas would continue discussions with CMS about the requirements for a five-year renewal during the 15-month extension. The waiver is currently set to expire September 2016.

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